<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('商户名称')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name" class="form-control" name="row[name]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">内部编码:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-agent_code" class="form-control" name="row[agent_code]" type="text">
            <span style="color: red;">可以不填</span>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('联系人')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-contacts" class="form-control" name="row[contacts]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">联系手机:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-phone" class="form-control" name="row[phone]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">QQ号:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-qq" class="form-control" name="row[qq]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">邮箱号:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-email" class="form-control" name="row[email]" type="text">
        </div>
    </div>
    <!-- <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Status')}:</label>
        <div class="col-xs-12 col-sm-8">
            {:build_radios('row[status]', ['hot'=>__('火热'), 'nothot'=>__('正常')])}
        </div>
    </div>  -->
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('省市区')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="form-inline" data-toggle="cxselect" data-selects="province,city,area">
                <select class="province form-control" name="row[province_id]" data-url="retail/partner/cxselect?area_code=0"></select>
                <select class="city form-control" name="row[city_id]" data-query-name="area_code" data-url="retail/partner/cxselect"></select>
                <select class="area form-control" name="row[area_id]" data-query-name="area_code" data-url="retail/partner/cxselect"></select>
            </div>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">地址:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-address" class="form-control" name="row[address]" type="text">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
